Operative Note – Neurosurgery (Cranial or Spinal)

Operative Note – Neurosurgery (Cranial or Spinal) Procedure Performed: Elective right-sided craniotomy for excision of frontal lobe tumour, performed on 1 November 2024 at 09:30. Surgical Team: Primary Surgeon: Dr. Anya Sharma Assistant: Dr. Ben Carter Anaesthetist: Dr. Christine Davies Scrub Nurse: Sarah Jenkins, RN Circulating Nurse: Mark Thompson, RN Preoperative Diagnosis: Right frontal lobe glioblastoma multiforme, confirmed by MRI with spectroscopy and prior biopsy. Anaesthesia and Positioning: General endotracheal anaesthesia. Patient was positioned supine with the head slightly elevated and turned to the left, secured in a Mayfield head clamp. Pressure points were padded meticulously. Surgical Approach and Technique: Curvilinear scalp incision over the right frontal region. Subgaleal dissection to expose the cranium. A 5x4 cm right frontal craniotomy flap was raised using a high-speed craniotome. The dura was opened in a C-shaped fashion, base towards the superior sagittal sinus. Intraoperative neuronavigation was used to precisely locate the tumour boundaries. Microscopic dissection was performed to meticulously resect the tumour, utilising ultrasonic aspirator and bipolar cautery. Gross total resection achieved, confirmed by intraoperative ultrasound. Hemostasis was secured. Dura was closed primarily with 4-0 Nurolon sutures, reinforced with dural substitute. Craniotomy flap was secured with titanium miniplates. Scalp closed in layers. Intraoperative Findings: Large, firm, poorly demarcated right frontal lobe tumour, approximately 4.5 cm in greatest dimension, with areas of central necrosis and peritumoural oedema. No significant adherence to major vessels or eloquent cortex observed. Brain appeared well-perfused post-resection. No dural tears or CSF leak noted. Specimens and Implants: Tumour tissue sent for histopathology and molecular analysis. No implants placed. Intraoperative Complications: Estimated blood loss was 250 ml. No neural injury, hardware misplacement, CSF leak, or anaesthetic complications. Blood Loss and Fluid Management: Estimated blood loss: 250 ml Fluids administered: 1500 ml Hartmann's solution Urine output: 400 ml Postoperative Plan: Transfer to Neuro-Intensive Care Unit (NICU) for 24-hour observation. Postoperative CT head to be performed within 6 hours. Continue Dexamethasone 8mg IV TDS. Prophylactic Ceftriaxone 1g IV BD for 48 hours. Strict neurological monitoring every hour for 24 hours, then as per protocol. Pain management with IV paracetamol and PRN opiates. Wound care: dressing change on post-op day 2. No drains placed.